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Endometriosis surgery

Description of endometriosis

Endometriosis affects an estimated 10 to 15% of women and girls worldwide, usually during their reproductive years regardless of their ethnic and social background. But 80% of the population has never even heard of endometriosis. Therefore, many remain undiagnosed and often not treated. Endometriosis is a condition where tissue similar to the lining of the uterus (which should only be located inside the uterus) is found elsewhere in the body. In these locations outside the uterus, the endometrial tissue has developed into what are called nodules, tumors, lesions, implants or growths. Some experts believe that pieces of endometrium have traveled back through the fallopian tubes and passed out into the pelvic cavity (space inside the pelvis that holds the reproductive organs). Tiny pieces of tissue may lodge on surfaces of the reproductive organs.

During menstruation, these pieces of tissue bleed, just like the endometrium inside the uterus. Surrounding tissue may become inflamed. Over time, unwanted scar tissue and cysts can form. Therefore, these endometriosis growths can cause severe chronic pain, infertility, and other problems. Endometrial growths are generally not malignant or cancerous, they are a type of normal type of tissue outside the normal location. However, in recent decades there has been an increased frequency of malignancy occurring or being recognized in conjunction with endometriosis.

Most common locations of endometriosis growths

Endometriosis lesions can be found anywhere in the pelvic cavity. The most common locations of endometrial growths are in the abdomen-involving the ovaries, fallopian tubes, the ligaments supporting the uterus, the area between the vagina and the rectum, the outer surface of the uterus, and the lining of the pelvic cavity. Sometimes the growths are also found in abdominal surgery scars, on the intestines or in the rectum, on the bladder, vagina, cervix, and vulva. In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, in the lung, spine, and brain. Endometriosis can also cause scar tissue and adhesions that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a “frozen pelvis.” This is not common, but it does happen.

Symptoms of endometriosis

The most common symptoms of endometriosis are pain before and during periods (usually worse than "normal" menstrual cramps), during or after sexual activity, infertility, and heavy or irregular bleeding. Other symptoms may include fatigue; painful bowel movements with periods; lower back pain with periods; diarrhea and/or constipation and other intestinal upset with some periods. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle – this is what makes this disease so unpredictable and frustrating. These symptoms may occur in young age, with the first menstruations. Endometriosis can be a chronic condition, with symptoms ranging from mild to severe.

Endometriosis is often also the cause of pain during and after sex. Complicating matters further is the fact that endometriosis can affect every organ or area of the body (except the spleen). As a result, pain can manifest essentially anywhere in the body. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways. Main symptoms include:

• Very painful menstrual cramps
• More frequent periods, irregular bleeding
• Painful sex, pain during or after intercourse
• Difficulty becoming pregnant, infertility, sterility
• Abdominal cramps or back pain during (and sometimes after) menstruation
• Painful bowel movements
• Constipation, diarrhea intestinal pain or upset stomach
• Pain or bleeding with urination
• Pain that resembles to cystitis
• Nausea or vomiting
• Fatigue

There is no connection between the symptoms and severity or extent of endometriosis. In other words, patients with very mild disease may have very severe symptoms while those with significant disease may not experience significant symptoms. A woman who has started menstrations at a young age or has a mother or sister with endometriosis is much more likely to develop endometriosis than other women.

Diagnosis of endometriosis

Diagnosing endometriosis can be difficult for a non-specialist because symptoms can vary widely and the only way to definitely diagnose endometriosis is by undergoing a surgical procedure called a laparoscopy. Therefore, diagnosis of endometriosis is generally considered uncertain until proven by laparoscopy. In this diagnosis procedure, a small scope is inserted through a very small incision in the abdomen so the physician can look for endometrial implants. If the diagnosis is clear, the gynecological surgeon (specialized and experienced in endometriosis surgery) will remove the implants during this surgery.

Infertility and sterility due to endometriosis

It is estimated that 30-40% of women with endometriosis may not be able to have children. In fact, 30% to 50% of infertile women have endometriosis. Women with endometriosis take longer to conceive (become pregnant) and are less likely to conceive than women in general. Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality. Hormonal drugs are not proved to be an effective treatment choice for endometriosis-related infertility, as none of the drugs seem to lead to better pregnancy rates.

Removing endometriosis implants by laparoscopy or robot surgery is the best choice. Sometimes, endometriosis even grows inside the ovary and forms a cyst (endometrioma). Laparoscopic surgery will restore the normal anatomy and will allow the reproductive organs to function more normally. Laparoscopic surgery and medical therapy together are effective treatments for endometriosis-related infertility, as they lead to better pregnancy rates, and also help to conceive through in vitro fertilization (IVF).

Endometriosis treatment

There are many medical treatments, which may relieve pain, but they will not cure endometriosis. Many women end up seeing their doctor numerous times before they are finally referred to a surgeon. Laparoscopy and robot surgery are Gold Standards for endometriosis treatment. If endometriosis is seen at the time of diagnosis, the endometriosis specialist will surgically remove the endometriosis implants and scar tissues. In operative laparoscopy, surgery is carried out through the laparoscope using laser, cautery, or small surgical instruments.

Radical surgery, involving hysterectomy and removal of all growths and the ovaries (to prevent further hormonal stimulation) becomes necessary in cases of long-standing, troublesome endometriosis. If the endometriosis has damaged organs, or resulted in them being stuck in abnormal positions, the surgeon will also try to repair the damages and restore the anatomy of the organs to as close as possible to their normal positioning. The best results are those obtained by experienced endometriosis surgeons using non-invasive laparoscopy and robot surgery in high technology operation theatres.


© Dr. Jean-Marie Wenger 2016
Avenue de la Roseraie 76A, 1205 Geneva, Switzerland
  +41 22 321 26 66 |   +41 22 321 26 70

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